MEDICARE: INFECTIOUS DISEASES PHYSICIANS OF SAN DIEGO, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	G41894	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073547667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASES PHYSICIANS OF SAN DIEGO, INC.

Provider Business Mailing Address
First Line	:	4136 BACHMAN PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2028
Country	:	US
Telephone Number	:	619-298-1443
Fax Number	:	619-298-6188

Provider Business Practice Location Address
First Line	:	4136 BACHMAN PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2028
Country	:	US
Telephone Number	:	619-298-1443
Fax Number	:	619-298-6188

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAMMY PAPPAS
Credential	:
Telephone Number	:	619-298-1443

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/20/2022

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